Mudavath Priyanka, Gurajala Indira, Kaluvala Prasad R, Durga Padmaja
Department of Anaesthesiology and Intensive Care, ESI Hospital, Sanathnagar, Hyderabad, Telangana, India.
Department of Anaesthesiology and Intensive Care, NIMS, Hyderabad, Telangana, India.
Indian J Anaesth. 2023 May;67(5):452-456. doi: 10.4103/ija.ija_741_22. Epub 2023 May 11.
Most studies have found that lumbar epidural catheterisation is technically easier with a paramedian than median approach. There is scant literature comparing the two approaches to the epidural space in the mid-thoracic spine. This study aims to compare the median versus paramedian approaches in the location of epidural space in the T7-9 region in patients undergoing laparotomy under combined general and epidural anaesthesia.
A prospective observational study was conducted after ethical approval and written informed consent on 70 patients undergoing major abdominal surgery. The patients received epidural analgesia either through a median or paramedian approach (Group M, = 35 and Group P, = 35). The primary objective was the incidence of successful epidural catheter placement in the first attempt. The secondary objectives were the overall success rate, the requirement of change of intervertebral space, approach or operator and complications associated with the procedure.
Sixty-seven patients were analysed. Epidural catheter was placed successfully in the first attempt in 40% of patients in Group M and 78.1% in Group P ( = 0.003). The overall success rate was 74.3% in Group M and 87.5% in Group P ( = 0.223). The number of attempts in Group M was more (one attempt 14, two 6, three 5 and four 1) as compared to Group P (one 25, two 2, three 1 and four 0) ( = 0.014). The incidence of complications was comparable between the groups.
Epidural catheter insertion was technically easier in paramedian as compared to the median approach in T7-9 thoracic region with no difference in complications.
大多数研究发现，旁正中入路进行腰椎硬膜外导管置入在技术上比正中入路更容易。比较两种入路进入胸段脊柱中段硬膜外间隙的文献很少。本研究旨在比较在全身麻醉联合硬膜外麻醉下行剖腹手术患者的T7 - 9区域硬膜外间隙定位时正中入路与旁正中入路的差异。
在获得伦理批准并取得书面知情同意后，对70例行大腹部手术的患者进行了一项前瞻性观察研究。患者通过正中或旁正中入路接受硬膜外镇痛（M组，n = 35；P组，n = 35）。主要目标是首次尝试硬膜外导管置入成功的发生率。次要目标是总体成功率、椎间隙、入路或操作者改变的需求以及与该操作相关的并发症。
分析了67例患者。M组40%的患者首次尝试成功置入硬膜外导管，P组为78.1%（P = 0.003）。M组总体成功率为74.3%，P组为87.5%（P = 0.223）。与P组（一次25例、两次2例、三次1例、四次0例）相比，M组尝试次数更多（一次14例、两次6例、三次5例、四次1例）（P = 0.014）。两组并发症发生率相当。
在T7 - 9胸段区域，旁正中入路进行硬膜外导管插入在技术上比正中入路更容易，且并发症无差异。
